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MFP Installation
Sales Rep:
Branch:
Sales Rep Email:
Customer Information
Customer Name:
Contact Name:
Contact Phone:
Alt. Phone:
Fax:
Email Address:
Address:
City:
State/Region:
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AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
ME
MD
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VI
VT
VA
WA
WI
WV
WY
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AB
BC
MB
NB
NL
NS
NU
ON
PE
QC
SK
YT
Zip/Postal Code:
Network Information
Open Network Drop?
Yes:
No:
Do they have on-site IT?
Yes:
No:
Do they have a server?
Yes:
No:
Number of Workstations to Setup:
Does FM Audit need to be installed?
Yes:
No:
MFP Information
Make/Model:
Delivery Date:
# of MFP's:
# of Controllers:
Scan to Folder?
Yes:
No:
Scan to Email?
Yes:
No:
Any Additional Notes:
Verification Image:
Enter Verification Image:
(only 6 lower-case letters)